2020 Volume 53 Issue 6 Pages 481-486
An 84-year-old man was admitted to our hospital complaining of postprandial abdominal pain. He had undergone distal gastrectomy and Roux-en-Y reconstruction for gastric cancer six years previously, and cholecystectomy and bile duct duodenal anastomosis for cholecystolithiasis, choledocholithiasis, and parapapillary duodenal diverticulum syndrome one year previously. Abdominal MRI revealed a low-signal structure in the afferent loop, and the patient was given a diagnosis of afferent loop syndrome due to incarceration of a calculus. Emergency surgery via an abdominal midline incision was performed. A calculus was palpable in the jejunum 5 cm from the ligament of Treitz on the anal side. An incision was made in this portion of the jejunum, and the jejunum was excised and closed with simple sutures. The patient was discharged from hospital 23 days after surgery. The excised calculi were mainly composed of calcium stearate. The calcium stearate was relatively high in bilirubin calcium among bile stones and was also included in the magnesium oxide that the patient had been taking. We considered the calcium stearate in this patient to have been deposited around a gastrolith as the nucleus. We report a case of afferent loop syndrome caused by bezoar-derived enterolithiasis comprised of calcium stearate as this is a very rare disease.
